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Major Depression Resource Center

Why Major Depression Can Go Undiagnosed

Friends and family can help a loved one get diagnosed and treated for depression.

Major depressive disorder is a leading cause of disability in the United States, affecting nearly 15 million adults each year. Studies have linked it to serious health problems such as obesity, type 2 diabetes, cardiovascular disease, and cancer. A recent study suggests depression can speed up the aging process by making our cells age faster. Yet major depression often goes undiagnosed or untreated because people won’t address it or those around them don’t recognize its signs.

“There’s still a lot of stigma about mental illness,” said Jon Lehrmann, MD, chairman of the psychiatry department at the Medical College of Wisconsin. “It’s a lot less than 10 or 20 years ago, but some people are just more reluctant to get help. That’s where they need doctors or family to be looking out for them and helping with treatment.”

Some symptoms of depression are not visible to others, such as feelings of hopelessness, guilt, or sadness. Experts agree, however, that there are tell-tale signs that friends, family, and co-workers can spot.

“Family and friends have a big influence on getting the person help,” said Kristin Kuntz, PhD, an assistant professor of clinical psychiatry at The Ohio State University. “They can’t make the diagnosis, but they can bring it to someone’s attention.”

According to Robin Kerner, PhD, director of quality initiatives and outcomes in the psychiatry department at St. Luke’s-Roosevelt Hospital in New York City, one of the most common indicators of depression is social withdrawal. A person may stop responding to phone calls, emails, and texts; keep canceling plans to meet with others; and start staying home all the time.

Other signs of depression to watch out for include:

Loss of interest in activities the person once enjoyed or did regularly.

Changes in sleep habits, such as sleeping too much or too little.

Changes in appetite, whether it’s eating too much or too little.

Anxiousness, irritability, and fatigue.

“These symptoms are affecting their daily functioning and everyday life,” said Kerner. But since the behaviors may be attributed to day-to-day stress or personal issues, people with major depression often don’t get a formal diagnosis early on.

“Usually by the time we see someone with depression, they’ve been trying to cope with these symptoms for a long time,” said Kerner.

Even when signs of depression are spotted, getting a person to seek help can be very challenging. “People with depression typically don’t want to think about treatment,” said Kuntz. “The depression itself makes them less likely to get treatment too.”

If a depressed person won’t respond to family and friends, it may be necessary to get a primary care doctor to intervene. More family doctors are starting to screen for depression at checkups, and they will refer patients to a therapist who can come up with a treatment plan.

As Kuntz points out, “there’s more evidence out there that there’s not overall health without mental health.”

For many patients, cognitive behavioral therapy (CBT) can help them “understand the way they’re thinking or perceiving themselves, and then change those thoughts or behaviors,” according to Kerner. CBT, which may be prescribed along with medications or on its own, seeks to replace the patient’s “false self-beliefs” with positive, self-affirming thoughts.

“If you initiate treatment for depression, it’s not a lifelong sentence,” said Kerner. “But if it goes untreated, quality of life is greatly affected.”

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